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The Three Stages of DIEP / GAP Free Flap Breast Reconstruction

April 22, 2011 by

The below question is answered by Christina Hobgood Naugle, PA-C, of The Center for Natural Breast Reconstruction.

charleston breast surgeons

Christina Hobgood Naugle, PA-C

What are the stages involved in DIEP / GAP free flap breast reconstruction?

The stages of breast free flap reconstruction at our facility can vary depending upon what time in the treatment process we initially meet the patient. The best scenario occurs when the treatment is mastectomy, alone. In those patients, we are able to discuss a skin and possible nipple-sparring mastectomy. This approach means that there is a possibility that the patient would only require one step, although most women are not opposed to a second stage when liposuction, “body contouring,” is involved. Many patients do not have this opportunity, so for them, this process usually involves three stages.

The first stage, being the most involved, is the “technical” stage—the microsurgery element.  After meeting with one of our physicians and discussing the best donor site tissue (tummy, buttocks or inner thigh) the process begins and we relocate the tissue to form a new breast mound. Only the donor site fatty tissue and the blood vessels that nourish that tissue are removed. NO muscle is sacrificed. This blood supply is separated from the body and reconnected to the vessel in the chest wall that once nourished the native breast.

Since the new breast mound is solely relying on the tiny vessels we reconnected initially, we keep you in the hospital for four days to monitor the blood flow into the relocated tissue. This stage of the procedure can require about a six to eight week recovery period, depending upon healing. It varies greatly when women are feeling well enough to return to work or resume the activities they enjoyed prior to surgery.

About three months after Stage One, we may begin discussing each specific patient’s Stage Two.  Three months is the minimum amount of time that we allow. In some cases, we recommend waiting slightly longer than three months (example: radiated tissue, healing issues, or unilateral reconstruction).

Stage Two could be described as the “plastic surgery” side of the breast reconstruction. This is the stage where we fine tune everything that was accomplished in the first procedure, and attempt to improve upon your concerns and how clothes fit. During the first stage, we try our best to achieve symmetry between the two breasts, but sometimes the doctors are limited on the shaping that they are able to accomplish because of the microsurgery portion. Stage Two is about improving symmetry between the two breasts, re-building a nipple if needed, and improving the donor site. This is usually an outpatient hospital procedure but, on the rare occasion, the patient may need to stay overnight.

The procedures performed during this stage vary from person to person, according to their needs. Recovery time varies, too. It could be as little as a day or two weeks, according to the procedures that need to be performed to achieve your desired result.

Three months after your second stage, it is time for your areola tattoo, Stage Three. Women who were able to save their nipple / areola complex at Stage One do not require this stage and are complete at Stage Two. The tattoo is performed in the office under local anesthesia. There is really nothing to this phase. You may drive yourself to the office and expect to be out in one to two hours. It’s really a lot like a social visit and other than exposing your newly tattooed area to public bodies of water like swimming pools, lakes or beaches, there is not much aftercare to speak of. Simple local wound care is all that is required. The risks are minimal and infection and complications are rare.

Many women think of the tattooing as the final hurdle. The best comment I’ve heard was from a woman who stated that after the tattoo healed, she got out of the shower one day and upon looking in the mirror, felt like everything was behind her.

A few other things to keep in mind:

  • Scars look their worse at about three to six months, from that point they should steadily lighten and become less noticeable. It’s hard, but be patient. It takes a while for scars to fully mature and everyone is different.
  • You’ll meet with your surgeon and discuss the best case scenario for you and how to get your breast reconstruction accomplished in as few steps as possible. It is important, even though you are plagued with so many other physicians and concerns, to meet with your surgeon before you have your mastectomy to keep the surgical stages to a minimum. At this point, we’re able to discuss with you your breast surgeon incision site techniques and helpful concepts to improve you final outcome. We also ask your surgeon to weigh the amount of breast tissue removed. It helps for our reconstructive surgeons to know how much breast tissue was removed with your mastectomy and use that number to work toward  rebuilding your new breast, hopefully achieving a symmetrical result earlier in the process to minimize the number of surgical stages.

  • Most patients after the first stage have breast mounds and feel comfortable in clothing. If they must delay State Two of their procedure to undergo chemotherapy, build up time off from work, or just desire time with their family, they are not on a time restriction. (Do keep in mind your deductable.)

  • Vanity is not even a consideration in the breast reconstruction process and these surgeries are not cosmetic plastic surgical procedures. It all comes down to trying to get your body back together and make you as happy as possible, so you can move forward with your life and not have the reminder of everything that you have been through and overcome.
  • Procedures in the breast not affected by breast cancer are insurance covered reconstructive procedures, too. When patients have unilateral reconstruction, achieving symmetry is a little bit more complicated. We have to let the newly relocated tissue settle and heal. The second stage surgical procedures in this case can include, breast lift, reduction, and / or minor procedures to fine tune and attempt to achieve symmetry between the native and reconstructed breast.

We like our patients to discuss with us the things that bother them about their reconstructive result. There are usually things we can improve upon, whether it’s a local procedure in our office or an additional stage. The three stages described in this piece are an outline to the overall process.

Breast reconstruction cases vary and affect each individual differently based upon a number of factors. Some people require one stage and others two or three outpatient or minor procedures to return their bodies back to where they are comfortable and confident.  After you overcome the first stage, the rest are just fine tuning by standard outpatient procedures and local procedures. It is all about making you as comfortable and confident as possible.

—Christina Hobgood Naugle, PA-C

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A Look at the Second Annual Warriors Wear Pink MoBo Event

April 20, 2011 by

Guest post by Lee Heyward, owner of the Charleston Style Concierge.

Lee attended the Second Annual Warriors Wear Pink MoBo Event, and was one of the speakers.

See below for Lee’s guest post:

Last week I was honored to be a part of the 2nd Warriors Wear Pink MoBo, where shopping was not only fun, but went to a great cause.  Attendees shopped through a great selection of designer denim, fun accessories, and great spring wardrobe updates to benefit local “warriors” fighting breast cancer. I had the privilege of helping shoppers find and put together great spring outfits.

warriors wear pinkImage to the left of Lee Heyward at the Warriors Wear Pink MoBo Event.

The MoBo was a great way to add fun spring wardrobe updates on any budget. I always teach my clients to keep an open mind when shopping because you never know what you are going to find, and the MoBo was the place to find so many great deals. Shopping here was a fun way to add new pieces to your wardrobe while benefitting an amazing cause.  Pictured here are a few of the many MoBo racks.

Below are images taken at the event of some of the clothing, jewelry, and shoe racks:

breast cancer events

charleston style concierge

Charleston personal stylist

I’m so honored to have had the opportunity to become involved with the Warriors Wear Pink organization. After speaking for only a few minutes with Leslie Moore, the organization’s founder, I had chills and knew I wanted to help however I could. Leslie is a breast cancer survivor and founded Warriors Wear Pink to give other pink warriors inspiration, hope, advice, and a community to reach out to.

breast cancer awareness

For more information about Warriors Wear Pink visit the Warriors Wear Pink Promise Blog or get involved with them on Facebook.  I hope to see you at the next Warriors Wear Pink MoBo!

To find out more about Lee and the Charleston Style Concierge, click here to visit her website.

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Therapeutic Ways to Relieve Stress

April 18, 2011 by

meditationReducing stress is one of the most effective steps you can take to improve your health, and it can be one of the most challenging. Stress is a constant in our lives, but if you’re proactive about managing it, you’ll be surprised at how much better you’ll feel. This post will discuss three very effective ways to relieve stress and reduce health issues.

Yoga

Body postures of varying difficulty and controlled breathing exercises increase your physical flexibility, while meditation helps you focus on being peaceful and calm. This powerful mind / body combination makes yoga an extremely effective stress reliever. Yoga practitioners also enjoy increased strength and balance. Prominent medical facilities such as the Mayo Clinic recognize the role of yoga and meditation in health promotion and stress management.

In yoga, movements are precise and require concentration, which draws your attention away from your hectic life and quiets your mind, so you release tension and anxiety. In addition to reducing stress, yoga has been proven to help with insomnia, depression, and fatigue. Yoga also lowers blood pressure and is used as a weight loss aid.

Journaling

Often we hide thoughts and feelings that cause stress, and we do our best not to think about them. However, stress is like any other untreated wound in that it becomes larger and more damaging if we don’t take care of it. Journaling, which is simply writing down your thoughts, allows you to express those feelings and understand their effects on your health.

When you see those thoughts on paper—especially after the strong emotions connected to them have passed—they lose their power to upset you, and their hold on your mind is broken. The stress these thoughts caused dissipates as a result. When you look objectively at what is going through your mind, you can define what is causing your stress and take steps to remedy it. For many, the act of writing helps them process their feelings, and that alone helps their stress levels.

Meditation

A quick and easy way to reduce stress, meditation is one mental technique of focusing your attention away from stressful thoughts and situations, giving you a sense of balance and peace. In addition to stress relief, the Mayo Clinic has found that meditation helps with pain management, allergies, binge eating, and sleep problems.

When you meditate, you intentionally move your mind into a new state of relaxation that extends throughout your body. Stressful feelings and thoughts are released as you move into a deeper state of awareness. As you become more proficient in meditation, you control your conscious thoughts more easily and relax more quickly.

To learn yoga, journaling, or meditation, search for classes in your area. Look at the instructors’ websites, or call them, and decide who seems knowledgeable and approachable. Often instructors will offer a class or a visit for low or no cost. Don’t be afraid to try something new to reduce your stress.

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What is Fat Necrosis and Should I Be Concerned About It?

April 15, 2011 by

The below question is answered by Dr. James Craigie of The Center for Natural Breast Reconstruction.

Dr. James Craigie

After my stage one DIEP surgery, I have some lumpy areas that I am told are fat necrosis.  Do they go away or what can you do about them? I am due to have stage two of my surgery soon.

Fat necrosis is a generalized term that results following injury or surgery when fat no longer has an adequate blood supply to survive. When fat does not survive and is in the breast the body develops scar or firmness as part of the healing process. A small amount of fat necrosis may go away on its own and larger amounts may persist indefinitely making the breast feel hard.

Following a DIEP or other muscle sparing breast reconstruction some of the fat transferred to the breast may not receive enough blood supply to survive the healing process. When this happens you may feel small lumps in the new breast about 1 – 2 months after the first surgery, sometimes sooner depending on where the lump is. These are usually small areas that can be removed at the second stage without affecting the end result. This is the most common situation we encounter.

On a larger scale, if something has occurred during the course of surgery and the tissue was transferred with an inadequate blood supply, the entire breast or a major portion of it could develop into fat necrosis. This is the most severe situation and would be considered a major complication or even failure of the procedure. Fortunately, in our experience, this situation is rare and the surgeon will know this has happened and should discuss options for correction.

If someone has a new breast lump and has a history of breast cancer, they are likely to undergo biopsies or have some concern over the area. Lumps that are fat necrosis may make breast exams more difficult or confusing and increase the chance that a new cancer or recurrence goes undetected. So anytime there is obvious fat necrosis after the first stage of surgery, we would make attempts to remove it. Initially, when a patient states they feel a firm area, I always remind them that what they feel on the outside will feel larger than the actual amount of fat necrosis tissue because the body is creating a reaction to the tissue trying to dissolve it.

It should be stressed that even patients who have undergone breast reconstruction should continue to do breast self-examinations. Any surgery on the breast will cause swelling and scarring. In many women who undergo reconstruction with breast implants, the body creates a capsule in response to these implants and all of these scars, capsules, or post surgical changes can feel like lumps and bumps following surgery. Therefore, it is important to know that fat necrosis may become apparent soon after surgery and should stay the same and not enlarge as time goes by. Alert your doctor regarding any breast lump that seems to enlarge. It is also important to know that breast exams will not be useful until after stage one and two are completed and the breast has had several months to recover from the surgery.

Once the reconstructive process is complete, things should not be changing. Patients should become familiar with any area that feels firm. If there are scars remaining after surgery, the patient should keep track of where they are and monitor them for changes. Changes in size or significant changes of any type should always be brought to the attention of your physician even in a reconstructed breast.

—James Craigie, M.D.

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Your Insurance and Financial Options for Breast Reconstruction: Know Your Options

April 13, 2011 by

Post by Gail Lanter, CPC Office Manager

Image to the left taken from The United States Department of Labor website.

A large part of my day is spent answering questions for women who are exploring their breast reconstruction options. These ladies are all potential patients of our practice and my mission is to help them make educated, informed decisions regarding a procedure, location, and time that are right for them. Ultimately, the discussion always turns to the insurance and financial part of the surgical procedure.

I’ll be honest. Sometimes the questions are surprising and a bit alarming when it comes to this end of things. There are women out there who are not aware of WHCRA 1998, the law that empowers women to elect to have the breast reconstruction procedure of their choice. In short, it states that if their insurance company covers mastectomy . . ., they have to cover your elected breast reconstruction procedure and any procedure required to achieve symmetry if you only have one affected breast.

Of course, just like anything else, there are always exceptions, but I would venture to say it covers the majority of women in the U.S. Read it here. It’s a law designed to protect your rights, and it’s important to know if you have had or are facing mastectomy.

***It’s not cosmetic surgery. Plastic surgery for breast reconstruction after mastectomy is a functional issue, not a vanity item. You don’t have to have artificial implants if you don’t want them. The options are endless. Sure, some women are limited in their options, simply because there are medical and health issues some women face that may not make them candidates for some of the surgical procedures. But in general, there is something out there for just about everyone. It’s not a one- time shot either. You’ve tried implants, great, they worked out for you and you are happy. HOORAY! DONE!

If you’ve tried them and they didn’t work out, (i.e. you developed capsular contracture, a post operative infection, couldn’t bear the tissue expansion process, whatever the reason) you can choose to go another route. It’s completely up to you. Read, go online, ask your friends, ask someone in your support group, and get a 2nd and 3rd opinion. Sometimes it’s not easy to find the alternatives, but sooner or later you will find something that works for you. Ask a bunch of questions, and in turn, you’ll get a bunch of answers and opinions to consider. Don’t be afraid to travel—sometimes your local surgeon may not offer all of the breast reconstruction techniques that are available, new ones are developed all the time.

Think of it this way: I’m an excellent softball player, but if you are looking for someone for your basketball team, I’m not your girl. But, being a good pal, I’ll ask around and find you someone who will be a wonderful addition to your team. It’s what friends do for one another.

So ask your current surgeon, tell him or her that as much as you appreciate all they have done for you, you’d like to know if there are procedures available beyond what they offer. If they are good guys / girls, they’ll lead you in the right direction if they are out of options for you.

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Why It’s Important to Get Out of the House and Experience Life

April 11, 2011 by

happy lifeIt’s been said that as you get older, you won’t regret what you’ve done, but what you haven’t done. It’s easy to stay home and hibernate, and you certainly need time alone to reflect and think, but you also need to connect—with people, with things, with places, and most important, with yourself.

Life is full of abundance and beauty, and it always has exciting adventures for you to discover. Some are as simple as hearing the tinkle of children’s laughter or watching a tulip emerge from the frost. Other experiences, such as camping in the mountains or going to a rock concert, fill all your senses with wonder and delight. Trying something new is stimulating and memorable, and it makes you feel truly alive as it enriches your life.

It’s easy to fall into the rut of staying in the house and watching TV or reading, and the thought of trying new things can be daunting. However, when you’re ready, adventure begins the moment you open your door. New experiences don’t have to be complicated or expensive. Anything you haven’t seen, heard, felt, or tasted is brand new to you. Following are ten simple and inexpensive ideas to try.

  • Take a different route when you run errands, and try a new store or dry cleaner.
  • Plan a short road trip, and discover an area of your city or county you’ve never seen.
  • Drive with some friends or family to a nearby town and park your car, get out, and explore.
  • Go window shopping.
  • Plant your favorite flowers in your yard or in a window box.
  • Call a friend and try a new coffee shop or restaurant. Splurge on food or drink you’ve never tasted before.
  • Go to the theater and watch a movie from a genre you’re not familiar with. Try a new snack while you’re there.
  • Think about attractions or landmarks your town is famous for. Have you ever seen them? If not, go.
  • Take a class in something you’ve always wanted to learn, such as a foreign language, cooking, or writing.
  • Imagine yourself doing an activity you’ve always been hesitant to try, such as riding a roller coaster or racing go-karts. Then do it.

Once you start exploring the world around you, you’ll be hooked and want more. What adventures are you ready to try?

 

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Is a DIEP Flap Reconstruction Right for You?

April 8, 2011 by

 

The below question is answered by Dr. Richard M. Kline, Jr., of The Center for Natural Breast Reconstruction.

My plastic surgeon told me that I did not have enough excess tissue in my abdomen to have a DIEP. What can I do now?

That’s a common question, thanks for asking. Many women wonder themselves if they actually have enough tissue for DIEP flap reconstruction, and others are told by their plastic surgeon that they do not. When assessing whether or not a patient’s abdomen can meet their reconstructive needs, several factors need to be taken into account.

First, are we talking about reconstructing one breast, or both breasts? Obviously, reconstructing both breasts takes twice as much tissue as reconstructing one breast. When only one breast is needed, it is possible to use both sides of the abdomen to reconstruct just one breast. This is called a “stacked flap,” which utilizes both sides of the abdomen, with two separate blood supplies, to make just one breast. We routinely do this procedure for patients who just need one breast reconstruction, but require both sides of their abdomen to get the size breast that they desire. It’s more complicated than connecting just one blood supply, but our practice has performed this operation well over a hundred times, with excellent success. In fact, we believe that stacked flaps may be less susceptible to fat necrosis (a complication of DIEP flaps where some of the fat, usually on the edge, dies and gets hard) than ordinary DIEP flaps.

Second, in trying to answer this question, the patient’s desired breast size must be taken into account. A patient who wants both breasts reconstructed to size “D,” but who does not have enough abdominal tissue to make a” D” size breast on each side, might have adequate tissue to make a “B” sized breast on each side. In this situation, if “B” sized breasts would not be acceptable to the patient, then we would usually recommend using the buttocks (a GAP flap) as the donor site.

Use of the buttocks for breast reconstruction, particularly for reconstructing both breasts at the same surgery, is significantly more complicated than using the DIEP flap. Fortunately, we have extensive experience with this procedure, having performed it several hundred times with a 99% success rate. If a patient did not wish to use their buttocks as the donor site, then they would still have the option of accepting a smaller breast size from the abdomen, or they may possibly decide to use implants, foregoing autologous reconstruction altogether.

Finally, for the patient who is told by their surgeon that they do not have enough tissue for a DIEP flap, it is worth noting that it can be extremely difficult for a surgeon who does not routinely perform DIEP flaps to properly assess the amount of donor tissue a patient has available in her abdomen. The thickness of the subcutaneous fat, which is the thickness that can be “pinched” between the skin and the muscle of the abdominal wall, is of paramount importance in assessing how large a breast can be made from the DIEP flap.

In addition, the maximum height of the flap also plays a role in determining what size breast can be made. In assessing how “high” a flap can be safely harvested from the abdomen, it is important to look at how much loose skin is present between the belly button and the bottom of the ribs.  If there is a lot of loose skin in this area, then it will stretch downward more easily to close the lower abdominal wound after harvest of the flap, thus allowing for a larger flap to be obtained. Again, precise assessment of the availability of abdominal donor tissue requires a significant amount of experience on the part of the surgeon, and is ideally performed while examining the patient in person, as opposed to simply looking at photographs.

In closing, to determine if a patient has “enough tissue for a DIEP flap,” we must ask these questions:

  • Are we reconstructing one or both breasts?
  • What size breast are we attempting to reconstruct?
  • What is an experienced surgeon’s assessment of how much tissue can be removed from the abdomen?

Only by taking all of the above into account can a meaningful answer to the question be obtained. We believe that effective communication between the patient and the reconstructive team, in this situation and in most others, is often the key to a successful and happy outcome.

—Richard M. Kline, Jr., M.D.

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Fabulous Shopping for a Fabulous Cause: The Second Warriors Wear Pink Event

April 6, 2011 by
Image to the left taken from WarriorsWearPink.com.

Support a great cause by coming out to the 2nd Warriors Wear Pink MoBo event, happening Thursday, April 7 from 5:30 p.m. to 8:30 p.m. The event takes place at the Tanner Hall Amenities Center in Tanner Hall Plantation and features fabulous guests including the Charleston Style Concierge, Lee Heyward; Elizabeth Quinton of EQMake Up; Sumner Little of Stella & Dot Jewelry; and the Rosita Jones Studio.

This is going to be an amazing night full of fun, shopping, and socializing! Those who attend the event will be helping to support local breast cancer survivors and those affected by breast cancer. Attendees can shop some great deals for an exceptional cause while listening to great music, socializing with family and friends, and enjoying a glass of wine and snacks.

Some of the items being sold at this event will include high-end, gently used clothing and fashionable accessories at great deals. Part of the proceeds will be given to locals affected by breast cancer, as well as the Warriors Wear Pink Foundation. Lee Heyward, the Charleston Style Concierge, will offer style expert assistance to shoppers looking to get some insight on wardrobe creations and pairings.

Don’t miss out on this great event to help support our brave local survivors and give to a wonderful cause!

For additional questions about the event, contact Leslie Crawford Moore at 843.708.1918.

Filed Under: All Things Charleston Tagged With: , , , , , , ,

Celebrating Those Who’ve Won the Battle Against Breast Cancer

April 4, 2011 by

It was an afternoon of motivation, education, and celebration at the Annual Komen Lowcountry Survivor Celebration held at the Embassy Suites Convention Center in Charleston, SC, on March 27. Survivors, along with their friends and families, gathered together for some afternoon tea to celebrate those who have won the battle against breast cancer—both here, in the Lowcountry, and around the world.

Guests enjoyed entertainment by singers from the Charleston County School of the Arts and Jazz Saxophonist Devon Gary. Survivor, Alex Costanzo, provided some laughs and good cheer with her “Top 10 Perks of Being a Breast Cancer Survivor.” Dr. Gretchen Meyer from Lowcountry Hematology & Oncologist provided the medical update portion of the program while Mona Palmore-Haynes stirred the crowd’s hearts and minds with her motivational speech about her own breast cancer experience.

The program closed with a moving candle lighting ceremony honoring the survivors in attendance. Congratulations to Gene Glave, who was the well deserved recipient of this years’ Charlene Daughtrey Award for her work with the Susan G. Komen for the Cure—Lowcountry Affiliate.

Thanks to Susan G. Komen for the Cure—Lowcountry Affiliate for such a truly beautiful and memorable day and The Center for Natural Breast Reconstruction for their sponsorship.

See more images from the event below:

breast cancer events

 

breast reconstruction surgeon

Dr. Richard Kline and Chris Murkami RN

Dr. Richard Kline

Dr. Richard Kline and his nurse, Chris Murkami RN

Visit our Facebook page to view videos from the event!

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Who Can Have a Skin-Sparing and Nipple-Sparing Mastectomy and Why?

April 1, 2011 by

**We are delighted to introduce our guest blogger, Dr. Paul Baron, MD F.A.C.S of Cancer Specialists of Charleston. Dr. Baron shares with us his insight on who can have a skin-sparing and nipple-sparing mastectomy and why.

See below for Dr. Baron’s guest post:

The best cosmetic results from breast reconstruction are clearly in patients who still keep much of the original skin of the breast. It leads to a more normal shape, appearance, and texture. In the past, the fear was that the cancer overlying a breast tumor needed to be removed; even if the cancer was far away from the skin in the back of the breast. All mastectomies were done with a large horizontal elliptical incision that removed a large segment of skin extending from the sternum to the lateral chest. The nipple and areola were removed at the same time as there was concern that the cancer could march up the ducts and be left behind if the nipple is left behind.  As a result, there was not enough pliable tissue to allow placement of an implant or tissue flap under the skin. The reconstruction could only be done by stretching the skin first with a tissue expander or leaving a large island of skin with the attached underlying flap of tissue (TRAM, latissimus, DIEP, or GAP). The result was a very unnatural breast reconstruction.

We now know that in most mastectomies, virtually all the skin overlying the breast can be left behind as long as the cancer is not immediately underneath it. In this case, we still remove a small patch of overlying skin. The most common incision for a skin-sparing mastectomy goes just around the areola with an extension inferiorly (kind of like a tennis racket shape), or a horizontal ellipse that is half the distance of the more traditional mastectomy incision. The resulting reconstruction is more natural in appearance as there is a very small scar and often no visible island of skin.

Another approach gaining in popularity is a nipple-sparing mastectomy. In this case, the entire breast is removed through an incision that completely leaves the nipple and areola intact. There are many ways to make this incision. Clearly these patients have the most normal appearing breast reconstruction. Also, to relieve the concern of cancer cells being left in the ducts, we actually core out the ducts as they enter the nipple. The shell of the nipple is left behind and as a result, often looks better than the nipple reconstruction.

We will not perform a nipple-sparing mastectomy if the cancer is close to the nipple. Also, if a patient had a prior mastectomy in which the nipple and areola were removed with one breast, we will usually remove the contra lateral nipple at the time of prophylactic mastectomy so the reconstruction result is symmetrical. It should also be pointed out that in most cases in which the nipple is left behind, it does not have normal sensation. It can have sensation to touch and temperature, but lose erotic sensation.

We have made huge strides in breast cancer surgery. For patients requiring or choosing mastectomy, the final reconstructed version can have a natural reconstruction as a result of usually leaving the skin behind as part of a skin-sparing mastectomy. We have improved this even more by performing nipple-sparing mastectomies. The optimum result is when the breast surgeon works as a team with the plastic surgeon in planning the type of mastectomy from a cancer point of view, and the orientation of the incision from a cosmetic point of view.

About Dr. Paul Baron:

Dr. Baron is Board Certified in General Surgery and completed a Surgical Oncology Fellowship at Memorial Sloan-Kettering Cancer Center in New York City. He is a graduate from the Boston University Six-Year Medical Program. Dr. Baron subsequently completed a residency in General Surgery at the Medical College of Virginia.

Cancer Specialists of Charleston – www.cancerspecialistsofcharleston.com

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